Electrocardiography score based on the Minnesota code classification system predicts cardiovascular mortality in an asymptomatic low-risk population
AbstractBackground The use of a single abnormal finding on electrocardiography (ECG) is not recommended for stratifying the risk of cardiovascular (CV) events in low-risk general populations because of its low discriminative power. However, the value of a scoring system containing multiple abnormal...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2023-12-01
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| Series: | Annals of Medicine |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/07853890.2023.2288306 |
| _version_ | 1797302169437732864 |
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| author | Wook-Dong Kim Yonggu Lee Byung Sik Kim Hyun-Jin Kim Jeong-Hun Shin Jin-Kyu Park Hwan-Cheol Park Young-Hyo Lim Jinho Shin |
| author_facet | Wook-Dong Kim Yonggu Lee Byung Sik Kim Hyun-Jin Kim Jeong-Hun Shin Jin-Kyu Park Hwan-Cheol Park Young-Hyo Lim Jinho Shin |
| author_sort | Wook-Dong Kim |
| collection | DOAJ |
| description | AbstractBackground The use of a single abnormal finding on electrocardiography (ECG) is not recommended for stratifying the risk of cardiovascular (CV) events in low-risk general populations because of its low discriminative power. However, the value of a scoring system containing multiple abnormal ECG findings for predicting CV death has not been sufficiently evaluated.Methods In a prospective community-based cohort study, 8417 participants without atherosclerotic CV diseases (ASCVDs) and any related symptoms were followed for 18 years. The standard 12-lead ECGs were recorded at baseline and the ECG findings were categorized using the Minnesota code classification. CV deaths were defined as death from myocardial infarction (MI), chronic ischemic heart disease, heart failure, fatal arrhythmia, cerebrovascular event, pulmonary thromboembolism, peripheral vascular disease and sudden cardiac arrest and identified using the Korean National Statistical Office (KOSTAT) database.Results In a multivariate Cox proportional hazard (CPH) model, major and minor ST-T wave abnormalities, atrial fibrillation (AF), Q waves in the anterior leads, the lack of Q waves in the posterior leads, high amplitudes of the left and right precordial leads, left axis deviation and sinus tachycardia were associated with higher risks of CV deaths. The ECG score consisted of these findings showed modest predictive values represented by C-statistics that ranged from 0.632 to 760 during the follow-up and performed better in the early follow-up period. The ECG score independently predicted CV death after adjustment for relevant covariates in a multivariate model, and improved the predictive performance of the 10-year ASCVD risk estimator and a model of conventional risk factors including age, diabetes and current smoking. The combined ECG score (Harrell’s C-index: 0.852, 95% confidence interval [CI], 0.828–0.876) composed of the ECG score and the conventional risk factors outperformed the 10-year ASCVD risk estimator (Harrell’s C-index: 0.806; 95% CI, 0.780–0.833) and the model of the conventional risk factors (Harrell’s C-index: 0.841, 95% CI, 0.817–0.865) and exhibited an excellent goodness of fit between the predicted and observed probabilities of CV death.Conclusions The ECG score could be useful to predict CV death independently and may add value to the conventional CV risk estimators regarding the risk stratification of CV death in asymptomatic low-risk general populations. |
| first_indexed | 2024-03-07T23:32:58Z |
| format | Article |
| id | doaj.art-c5dff7a8f7474271abe24f2da8744f95 |
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| issn | 0785-3890 1365-2060 |
| language | English |
| last_indexed | 2024-03-07T23:32:58Z |
| publishDate | 2023-12-01 |
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| series | Annals of Medicine |
| spelling | doaj.art-c5dff7a8f7474271abe24f2da8744f952024-02-20T11:58:23ZengTaylor & Francis GroupAnnals of Medicine0785-38901365-20602023-12-0155210.1080/07853890.2023.2288306Electrocardiography score based on the Minnesota code classification system predicts cardiovascular mortality in an asymptomatic low-risk populationWook-Dong Kim0Yonggu Lee1Byung Sik Kim2Hyun-Jin Kim3Jeong-Hun Shin4Jin-Kyu Park5Hwan-Cheol Park6Young-Hyo Lim7Jinho Shin8Department of Internal Medicine, Division of Cardiology, Hanyang University Guri Hospital, Guri City, Republic of KoreaDepartment of Internal Medicine, Division of Cardiology, Hanyang University Guri Hospital, Guri City, Republic of KoreaDepartment of Internal Medicine, Division of Cardiology, Hanyang University Guri Hospital, Guri City, Republic of KoreaDepartment of Internal Medicine, Division of Cardiology, Hanyang University Guri Hospital, Guri City, Republic of KoreaDepartment of Internal Medicine, Division of Cardiology, Hanyang University Guri Hospital, Guri City, Republic of KoreaDepartment of Internal Medicine, Division of Cardiology, Hanyang University Medical Center, Seoul, Republic of KoreaDepartment of Internal Medicine, Division of Cardiology, Hanyang University Guri Hospital, Guri City, Republic of KoreaDepartment of Internal Medicine, Division of Cardiology, Hanyang University Medical Center, Seoul, Republic of KoreaDepartment of Internal Medicine, Division of Cardiology, Hanyang University Medical Center, Seoul, Republic of KoreaAbstractBackground The use of a single abnormal finding on electrocardiography (ECG) is not recommended for stratifying the risk of cardiovascular (CV) events in low-risk general populations because of its low discriminative power. However, the value of a scoring system containing multiple abnormal ECG findings for predicting CV death has not been sufficiently evaluated.Methods In a prospective community-based cohort study, 8417 participants without atherosclerotic CV diseases (ASCVDs) and any related symptoms were followed for 18 years. The standard 12-lead ECGs were recorded at baseline and the ECG findings were categorized using the Minnesota code classification. CV deaths were defined as death from myocardial infarction (MI), chronic ischemic heart disease, heart failure, fatal arrhythmia, cerebrovascular event, pulmonary thromboembolism, peripheral vascular disease and sudden cardiac arrest and identified using the Korean National Statistical Office (KOSTAT) database.Results In a multivariate Cox proportional hazard (CPH) model, major and minor ST-T wave abnormalities, atrial fibrillation (AF), Q waves in the anterior leads, the lack of Q waves in the posterior leads, high amplitudes of the left and right precordial leads, left axis deviation and sinus tachycardia were associated with higher risks of CV deaths. The ECG score consisted of these findings showed modest predictive values represented by C-statistics that ranged from 0.632 to 760 during the follow-up and performed better in the early follow-up period. The ECG score independently predicted CV death after adjustment for relevant covariates in a multivariate model, and improved the predictive performance of the 10-year ASCVD risk estimator and a model of conventional risk factors including age, diabetes and current smoking. The combined ECG score (Harrell’s C-index: 0.852, 95% confidence interval [CI], 0.828–0.876) composed of the ECG score and the conventional risk factors outperformed the 10-year ASCVD risk estimator (Harrell’s C-index: 0.806; 95% CI, 0.780–0.833) and the model of the conventional risk factors (Harrell’s C-index: 0.841, 95% CI, 0.817–0.865) and exhibited an excellent goodness of fit between the predicted and observed probabilities of CV death.Conclusions The ECG score could be useful to predict CV death independently and may add value to the conventional CV risk estimators regarding the risk stratification of CV death in asymptomatic low-risk general populations.https://www.tandfonline.com/doi/10.1080/07853890.2023.2288306ElectrocardiographyMinnesota code classificationcardiovascular mortalitylow-risk population |
| spellingShingle | Wook-Dong Kim Yonggu Lee Byung Sik Kim Hyun-Jin Kim Jeong-Hun Shin Jin-Kyu Park Hwan-Cheol Park Young-Hyo Lim Jinho Shin Electrocardiography score based on the Minnesota code classification system predicts cardiovascular mortality in an asymptomatic low-risk population Annals of Medicine Electrocardiography Minnesota code classification cardiovascular mortality low-risk population |
| title | Electrocardiography score based on the Minnesota code classification system predicts cardiovascular mortality in an asymptomatic low-risk population |
| title_full | Electrocardiography score based on the Minnesota code classification system predicts cardiovascular mortality in an asymptomatic low-risk population |
| title_fullStr | Electrocardiography score based on the Minnesota code classification system predicts cardiovascular mortality in an asymptomatic low-risk population |
| title_full_unstemmed | Electrocardiography score based on the Minnesota code classification system predicts cardiovascular mortality in an asymptomatic low-risk population |
| title_short | Electrocardiography score based on the Minnesota code classification system predicts cardiovascular mortality in an asymptomatic low-risk population |
| title_sort | electrocardiography score based on the minnesota code classification system predicts cardiovascular mortality in an asymptomatic low risk population |
| topic | Electrocardiography Minnesota code classification cardiovascular mortality low-risk population |
| url | https://www.tandfonline.com/doi/10.1080/07853890.2023.2288306 |
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